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  • Updated 02.26.2024
  • Released 09.15.1994
  • Expires For CME 02.26.2027

TIAs (carotid)



The author provides an update on carotid transient ischemic attacks, with descriptions of new studies pertaining to antiplatelet therapy and transient ischemic attack prognosis. New imaging and treatment methods for carotid plaques are also discussed.

Key points

• Transient ischemic attacks are an important warning sign for stroke and deserve rapid evaluation and treatment.

• Risk stratification schemes can be useful for identifying the highest risk transient ischemic attack patients.

• Patients with transient ischemic attacks should receive rapid medical therapy (antithrombotic therapy for all, antihypertensives and statins for most) and carotid revascularization in select subjects.

• Short-term dual antiplatelet therapy is now recommended for high-risk patients with transient ischemic attacks.

Historical note and terminology

In 1951, Fisher described seven patients with internal carotid artery occlusion and transient or permanent ischemic symptoms using the words "brief transient attacks of paralysis" (22). In a separate publication that same year, Fisher linked occlusive disease at the internal carotid artery bifurcation to "transient episodes of blindness, aphasia, paresthesia and paralysis," "transient attacks," "premonitory fleeting," and "transient hemiplegia" (21). Fisher went on to credit many other investigators who, earlier in this century, identified similar symptoms in relation to internal carotid artery bifurcation disease. He was unsure about the mechanism of symptom production and speculated about the roles of thrombosis, vasospasm, and embolism.

This review addresses all transient ischemic attacks in the territory of the internal carotid artery or its branches: the ophthalmic artery, posterior communicating artery, anterior choroidal artery, anterior cerebral artery, and middle cerebral artery (52). The discussion will not be limited to carotid territory transient ischemic attacks that are due solely to occlusive disease at the internal carotid artery bifurcation.

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